Week 2: Ethnicity and health

Question 1

What is the ethnic diversity like in the UK population?

Answer 1

Majority 81% are white backgrounds
Followed by Asian and black communities
The proportion of ethnic minorities is increasing

Question 2

What are mental health outcomes like in ethnic minority groups?

Answer 2

More likely to experience mental health difficulties but are less likely to receive treatment
Are more likely to have schizophrenia
More likely to require severe treatment such as detention or community treatment orders.

Question 3

What is the prevelance of Type 2 diabetes in ethnic minority communities?

Answer 3

South asian communities (particularly bangladeshi and pakistani) and countries are six times more likely to develop T2D than white groups
Higher mortality and serious complication rates (cardiovascular, renal and cancer)
Sometimes less likely to seek treatment due to stigma around condition and their communities

Question 4

What is the prevelance of cardio-vascular disease among south asians?

Answer 4

Higher rates of prevelance and morality from cardiovascular disease than white minority groups
Particularly in Pakistani and bangladeshi groups
POtentiall lower rates in chinesse minorities

Question 5

What are the key ethnic differences in health between white and ehtnic minorty communities?

Answer 5

Higher rates of and morality from coronary and cardiovascular disease (High BP, myocardial infarction etc).
Increased risk of stroke
Higher risk of type 2 diabete in south asian population
Worse mental health outcomes

Question 6

What are effects in maternal and infant mortality in ethnic minority communities?

Answer 6

Black mothers are five times more likely to die during or after pregnancy
Infant mortality rates are also higher
Underpinned by deprivation

Question 7

How does the prevelance of obesity vary by minorty ethnic groups?

Answer 7

Higher in ethnic minorty groups
Particulary higher in black African, black Caribbean and bangladeshi communities
Alarming rates of childhood obesity - more likely to be obese as adults - suggests intervention needed when younger (lifecourse model)

Question 8

How does ethnicity affect COVID-19 statistics?
WHy?

Answer 8

Ethnic minorities are
More likley to die from COVID-19
More likely to catch COVID-19

Hesistance to seek treatment due to stigma ‘ Chinese Virus’
Socioeconomic - unable to work from home, people focused jobs as taxi drivers or shop workers, higher deprivation can’t afford time off work or to be put on furlough scheme

Question 9

What are the common causes of premature mortality in ethnic minority groups?

Answer 9

Cirrhosis Hepatitis C
Stoke
Neonatal preterm birth
heart disease
Stomach and prostate cancers

Question 10

How does cancer rates and treatments vary between different countries?
Why?

Answer 10

White majority typicall have a higher incidence of cancer, except a few conditions
HICs - higher incidence of cancers - better screening programmes and diagnosis
LICs - higher mortality rate - identify at later stage, poorer accesibility to treatment, limited health care resources, unable to fund preventable public health programmes

Question 11

What cancers are more common in ethnic minority groups?

Answer 11

Prostate cancer - x2 in black
Myeloma - x3 higher in black
Several gastrointestinal cancers - black and asian
Hodgkin lymphoma
Thyroid cancers

Question 12

How does breast cancer statistics show about the experience of ethnic minorities in the US?

Answer 12

Black minorities develop breast cancer at a higher rate and a younger age and higher mortality rate.
More likely to have triple negative breast cancer which is more difficult to treat and has higher mortality rates

Question 13

What are the three areas of cancer treatment that need targeting to reduce inequalities in ethnic minorities?

Answer 13

Screening
Diagnosis
Treatment

Question 14

What do statistics show about cancer screening in ethnic minorities?
Why?

Answer 14

Less likley to engage with screening programmes
Less accessible, less awareness, fear of process - does not align with cultural values

Question 15

What do statistics show about cancer diagnosis in ethnic minorities?
Why?

Answer 15

Recieve diagnosis at a later stage - leading to poorer outcomes
May be due to poor engagement with screening or healthcare failure to notice warning signs - many medical textbooks only show rashes etc on white pigmented skin

Question 16

What are the disparities in cancer treatment in ethnic minorty groups?

Answer 16

Worse survivial outcomes
Less likley to recieve stage appropriate treatment
More likely to have longer waiting times for treatment or refuse the treatment offered
Less frequent treated with chemotherapy and radiation
Less likely to follow up on negative screening results

Question 17

Why is it imporant to ensure ethnic minorities are included in clinical trials?

Answer 17

Clinical trials are used to model treatment guidelines
The patient population should be accurately represented to ensure the treatment is equally effective in all patient groups, reduce inequalities in treatment outcomes

Question 18

What is the deal with clinical trials and inequalities in ethnic minorities?

Answer 18

Less than 10% of cancer patients enrolled in clinical trials are racial or ethnic minorities

Question 19

What healthcare system based reasons are ethnic minorities more likely to receive worse outcomes?

Answer 19

Barriers accessing care - language, location, cost
Discrimination and bias or fear of this from healthcare staff
Lack of trust and poor engagement from health care provider
Screening programmes - do not adjust policies for groups that are at a higher risk e.g more likely to need screening at a younger age
Underepresentation in health care teams and clinical trials - system made to positively discriminate against the majority

Question 20

What biological and socioeconomic factors underpin why ethnic minorty groups are more likely to experience worse outcomes in healthcare?

Answer 20

Hereditary risk
Lack of awareness due to poor health literacy
Cultural stigma - screening is not modest
Disparities in exposure to risk factors - e.g more likely to liver in poverty or be obese
Difference in health literacy due to Black English - due to different cultural understandings and grammatical expectations

Question 21

What does the rainbow model or Dahlgren and Whiteheads model of the determinants of health show?

Answer 21

That broad social and economic circumstances can determine the quality of the health of the population - these are the social determinants of health
1. Biological, unmodifiable factors - gender and age
2. INdividual and lifestyle factors
3. Social and community networks
4. Living and working conditions
5. General socio-economic, cultural and environment conditions

Intervening at a more broad level is more likely to be affective for a greater number of people

Question 22

What are the different social determinants of health?

Answer 22

POverty
Social networks
Housing
Education
Employmeny conditions
Transport
Environment
Nutrition

Question 23

How does being in an ethnic minority correlate to levels od deprivation?

Answer 23

Ethnic minorites make up a disproportionatly large amount of people in disadvantaged backgrounds

Question 24

How does being in a ethnic minoty background effect you t work?

Answer 24

More likley to have concerns ignored or work in unsafe conditions
Less likely to be offered a job or called back for interviewing (even within the NHS)
Colleauges of a majority race often underestimate the challenges faced by minority groups in the work place

Question 25

How can we tackle inequality in ethnic minority groups in the NHS workforce?

Answer 25

Traina nd recuirt socially responsible and culutrually diverse healthcare workers
Develop a culture within the NHS without racism
Ensure staff are reflective of the communities we serve

Question 26

How can we reduced inequalities in ehtnic minority groups in medical treatment?

Answer 26

Abondon the one sixe fits all - tailor health campaign to the specific ethnic group or deliver in different ways in different communities
Acknowledge mistrust in medical research - combat this by including minority groups in clinical trails and educating about the pros/cons and involving of medical research
Work with communities to engage them in research.